Blossom Psychotherapy and Services

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

Legal business name

BLOSSOM PSYCHOTHERAPY AND SERVICES

Practice address

8608 Utica Ave
Rancho Cucamonga, CA 91730-4877

Phone

(909) 681-7858

NPI assigned

Mar 4, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Nicole M Mascarenbas, MFT

Title

Owner

Phone

(909) 681-7858

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1583280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583280000000",
    "number": "1568097186",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8344 HEATHER AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923358070",
            "telephone_number": "909-681-7858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8608 UTICA AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917304877",
            "telephone_number": "909-681-7858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOSSOM PSYCHOTHERAPY AND SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-04",
        "last_updated": "2020-03-04",
        "certification_date": "2020-03-04",
        "status": "A",
        "authorized_official_last_name": "MASCARENBAS",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "909-681-7858",
        "authorized_official_credential": "MFT"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Marriage & Family Therapist in Rancho Cucamonga, CA
• Providers in Rancho Cucamonga, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.